The last thing we wanted was to start a civil war…but if we aren’t living free, what are we living for????

Ukraine Dead Increase to 328 – Still No Sequences

The above numbers are in the latest update from the Ukraine Health Department and include 13 more deaths. Although the number of deaths has decline slightly from the prior two days, the increase in cases and hospitalizations suggest the decline in deaths may be temporary. The largest increase in cases was again in Kiev (5522 to 109,676) and two other eastern oblast (see map) had daily increases of more than 4000 cases (Dnipropetrovsk and Denetsk). The steady rise in deaths continues to increase concerns over an H1N1 genetic change leading to an increase in lung disease such as those described earlier.

WHO came out with a situation update which provided little specific information beyond earlier reports that the H1N1 did not have large changes. However, the new update did indicate that WHO regional centers in London and Atlanta were still investigating isolates, suggesting there have been sequences changes that are not fully characterized.

Recently released swine H1N1 from other locations have included receptor binding domain changes at position 225 (D225E, D225N, D225G) as well as 226 (Q226R) raising concerns that similar changes in Ukraine cold lead to the high frequency of fatal lung infections (Q226R has been seen previously in human H5N1 as well as H3 isolates from swine, ducks, and seals). The new update did not address receptor binding domain changes or other SNPs that could have significant effects on the pathogenicity of the virus.

Therefore, the release of sequences and comments on receptor binding domain changes would be useful.